Active NPI
Tracey Peterson, PHARM D
- Pharmacist
- Hayden, ID
National Provider Identifier
1992188056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P5462
- Practice address
- 16654 N Morgan LN
Hayden, ID 83835-5015 - Phone
- (208) 771-0802
- NPI assigned
- Jul 7, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P5462 | ID | Primary |
Addresses
Primary practice location
16654 N Morgan LN
Hayden, ID 83835-5015
Mailing address
16654 N Morgan LN
Hayden, ID 83835-5015
Phone (208) 771-0802
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P5462 | ID | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436227200000",
"number": "1992188056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16654 N MORGAN LN",
"city": "HAYDEN",
"state": "ID",
"postal_code": "838355015",
"telephone_number": "208-771-0802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16654 N MORGAN LN",
"city": "HAYDEN",
"state": "ID",
"postal_code": "838355015",
"telephone_number": "208-771-0802"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "TRACEY",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-07-07",
"last_updated": "2015-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P5462",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hayden, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.